If you are receiving Work First New Jersey/ General Assistance (WFNJ/GA), you are covered by NJ FamilyCare Plan G for most of your health care needs, except when you are in a hospital. If you are in a hospital, the state’s Charity Care program will cover your hospital bill, with some exceptions. The following will explain what FamilyCare Plan G covers and what Charity Care covers – and how you can get help if you cannot get the health care that you need.
Plan G: Non-Hospital Health Care Coverage
Plan G covers most medical care that you receive outside of a hospital when you receive it from a provider who takes Medicaid. Such providers are doctors, advanced practice nurses, dentists, pharmacies, clinics, labs, transportation companies, medical equipment suppliers, treatment facilities, etc. Plan G is different than the FamilyCare plans for families with minor children who are eligible for Work First New Jersey through Temporary Assistance for Needy Families (WFNJ/TANF).
The following are some examples of health care services that Plan G covers when the care is medically necessary and delivered outside of a hospital by a Medicaid provider. This list does not include everything and there are some coverage restrictions or limits.
- Physician’s services
- Dental care
- Prescription medicines
- Durable medical equipment
- Hearing aid services
- Medically-related transportation
- Chiropractic for spinal manipulation
- Laboratory and radiological services
- Ambulatory surgery (independent facility)
- Vision and eye glasses
- Podiatry services (not routine care)
- Prosthetics and orthotics
- Abortion services
- Independent clinic services
- Speech, occupational, and physical therapies
- Inpatient psychiatric services at Mt. Carmel Guild (Newark)
Charity Care: Hospital-Based Care
If you go to the hospital for care, whether you are admitted or you receive care in the Emergency Room or as an outpatient for day surgery or in a hospital-based clinic, you must apply for Charity Care to cover the cost of your care. But you will not have to go through the full application process that is required for other Charity Care applicants if you are receiving General Assistance.
Physicians who treat Charity Care patients in the hospital will sometimes bill the patients for the care, even though they know the patient has no insurance and qualifies for Charity Care – because only a hospital facility gets paid for Charity Care costs. These are doctors who are not considered part of the hospital’s staff because they contract with the hospital to treat patients in the hospital. These doctors do not get paid by Charity Care. Sometimes Medicaid doctors treat General Assistance patients in their offices outside of the hospital where they get paid for office visits by FamilyCare Plan G. But the doctors will refuse to treat the same patients in the hospital because they will not get paid by either FamilyCare or Charity Care. This can be a serious problem.
However, all general acute care hospitals are required to admit or give appropriate care to patients without regard to their ability to pay. What this means in practical terms is that a hospital must treat you if you need emergency or urgent hospital care. However, the doctor who usually treats you in his office may not be the same doctor who treats you in the hospital.
If you receive a bill for care that you received in a hospital or hospital-based facility, you should contact the Legal Services office in your county or the Health Care Access Project at Legal Services of New Jersey (1-888-576-5529) for help if you are eligible for General Assistance. If you are not eligible for General Assistance but you are uninsured and your income is below $32,490 a year (one person household), you may be still be eligible for free or reduced-cost hospital care through Charity Care.
Substance Abuse Services
If you are receiving General Assistance, you may receive free substance abuse services through the county-administered Substance Abuse Initiative (SAI). Referral to the program can be voluntary or mandatory. This program provides substance abuse screening, assessment, treatment placement, care coordination and utilization, and case management. And SAI participants’ hours of treatment count toward their required hours of WFNJ work activity when assessed and monitored by an SAI clinical case coordinator.
This information last reviewed 10/26/11